Causes and Consequences of Child Coping during Pediatric Oncology Treatment Episodes: A Secondary Data Analysis ABSTRACT Many pediatric cancer patients experience serious psychosocial problems during and after treatment. Designing interventions to reduce these problems and improve the quality of long-term survivorship requires understanding the origins of stressors underlying these psychosocial problems. Treatment episodes (defined as the time before, during, and immediately following treatment procedures) are one of the most stressful aspects of pediatric cancer, and child long-term outcomes are rooted in the treatment experience. As a result, children's negative responses to treatment episodes may place them at greater risk for negative psychosocial outcomes after treatment. Findings from our previous NIH-funded research show that differences in parent and child attributes (i.e., trait affect, temperament, resilience), child behavior problems (i.e., anxiety, depression, somatic problems, aggression), and parent state affect and communication are associated with children's global ratings of distress during treatment episodes. However, little is known about the role of child coping behaviors during these episodes and how these behaviors might mediate these relationships. Our long-term goal is to understand how factors that exist prior to treatment episodes and interpersonal processes during episodes influence child coping, and in turn, child responses to treatment episodes (i.e., distress behaviors during episodes and quality of life post-episode). Therefore, our primary objective in the proposed study is to extend our previous research with a secondary analysis of previously video-recorded pediatric oncology treatment episodes (and related parent and child variables) to achieve the following aims: Aim #1: Further develop and refine a coding system to systematically observe and analyze child coping and distress behaviors during treatment episodes Aim #2: Apply this coding system to an existing archive of video-recorded pediatric oncology treatment episodes that include parents and children (N = 41) Aim #3: Explore and empirically test relationships between observational ratings of child coping behaviors during treatment episodes and: (a) parent and child dispositional attributes, (b) child behavior problems, (c) parent communication and affect during episodes, and (d) child distress during treatment episodes (i.e., observed ratings of specific distress behaviors;global ratings by parents, nurses, children;and observed global ratings by trained coders) and child quality of life after treatment episodes. Our overarching research goal is to develop effective interventions to reduce distress and improve quality of life for pediatric cancer patients. This goal requires an improved understanding of the causes and consequences of children's coping during treatment episodes. We expect our proposed research to provide direct, empirical evidence to inform the development of future interventions to enhance child coping, thereby reducing distress during episodes and improving the long-term quality of life for survivors and their families. PUBLIC HEALTH RELEVANCE: Project Narrative Previous research shows that children's cancer treatment experiences are a factor in their long-term well- being and quality of survivorship. This study seeks to better understand the causes and the consequences of differences in children's coping during treatment episodes. We will refine and apply an observational coding system to an archive of previously collected video-recordings of child treatment visits and then analyze the relationships between child coping behaviors and several child and parent factors prior to, during, and following the treatment. We expect the findings of our proposed research to provide direct evidence to inform the development of interventions to facilitate children's positive coping during treatment episodes, thereby reducing their distress during episodes and improving the long-term quality of life for survivors and their families.